Volume 1

Contents
Contributors xi
Foreword by The Surgeon General xiii
Preface xv
Section I: Medical Ethics 1
1. The Moral Foundations of the Patient–Physician Relationship: The Essence of Medical Ethics 3
Edmund D. Pellegrino
The patient–physician relationship has evolved throughout the centuries, remaining the central basis for medical care during eras of paternalism, autonomy, and managed care.
2. Theories of Medical Ethics: The Philosophical Structure 23
David C. Thomasma
Medical ethics applies philosophical theories to clinical problems. There are competing theories, each with strengths and weaknesses, that can be used to analyze ethical issues.
3. Clinical Ethics: The Art of Medicine 61
John Collins Harvey
Clinical ethics is the practical application of ethical theory at the bedside. Ethics consultants and educators help clinicians grapple with ethical dilemmas in the patient–physician relationship. Seminal cases are discussed in an attachment to the chapter.
4. The Science Behind the Art: Empirical Research on Medical Ethics 105
Daniel P. Sulmasy
Research into the application of medical ethics uses rigorous methods of inquiry to examine the current status of thinking in the field. It describes, rather than applies, the use of ethical analysis in actual situations, including those unique to the military.

Section II: Military Ethics 127
5. The Profession of Arms and the Officer Corps 129
Anthony E. Hartle
The professional ethic for the American military has strong roots in history and provides a rich tradition and basis for right action in the pluralistic culture in society today.
6. Honor, Combat Ethics, and Military Culture 157
Faris R. Kirkland
Honor, one of the core values in military service, should be reciprocal between superiors and subordinates. Ethical leadership is an essential responsibility of those entrusted to command soldiers in combat.
7. The Military and Its Relationship to the Society It Serves 199
Nicholas G. Fotion
There are several models describing the relationship between the military and the society it serves that reflect the tension between a closed military culture and one more similar to, or even identical to, the civilian culture.
8. Just War Doctrine and the International Law of War 221
William V. O’Brien and Anthony C. Arend
Decisions to resort to war and how to conduct a war have been analyzed using moral theory. International laws of war and international conventions attempt to codify moral and legal restraints on these decisions.
9. The Soldier and Autonomy 251
Sandra L. Visser
The military mission requires significant individual sacrifices from the soldier, including some of his autonomy. Appropriately balancing individual liberty with the needs of the military requires rigorous ethical analysis and justification.

Section III: The Synthesis of Medicine and the Military 267
10. Physician-Soldier: A Moral Profession 269
William Madden and Brian S. Carter
The profession of medicine may appear to have opposite goals from the profession of arms, in that one involves healing and the other killing. In reality, however, the professions and their goals are remarkably similar and morally can be combined.
11. Physician-Soldier: A Moral Dilemma? 293
Victor W. Sidel and Barry Levy
In contradistinction to the previous chapter, these authors contend that conflicts arising between the ethos of both professions make it morally impossible for physicians to serve in the military.
Responses to the chapter by Edmund G. Howe, MD, JD and Dominic R. Rascona, MD
12. Mixed Agency in Military Medicine: Ethical Roles in Conflict 331
Edmund G. Howe
Mixed agency involves the conflict between duties to the individual patient and those to the military. Ethical analysis can be applied to resolving this conflict and, by so doing, emotional distress to the physician can be minimized.
Abbreviations and Acronyms xix
Index xxiii

Volume 2
Contents
Contributors xi
Foreword by The Surgeon General xiii
Preface xv
Section IV: Medical Ethics in the Military 367
13. Medical Ethics on the Battlefield: The Crucible of Military Medical Ethics 369
Thomas E. Beam, MD
The battlefield is perhaps the most difficult of all environments in which to practice medicine. Pressures from the threat of enemy attack as well as unique issues, such as returning soldier/patients to duty, triage or even
euthanasia on the battlefield, and physician participation in interrogation of prisoners of war, require agonizing choices.
14. Nazi Medical Ethics: Ordinary Doctors? 403
Robert N. Proctor, PhD
Medicine under the Nazi regime flourished and physicians participated, not as pawns but as pioneers, in the horrors of genocide and unethical experimentation. The reasons for this are varied and have many factors, but do not lessen the terror of physicians killing and torturing patients.
15. Nazi Hypothermia Research: Should the Data Be Used? 437
Robert S. Pozos, PhD
One of the better known examples of unethical research under the Nazi regime is that of the hypothermia experiments on prisoners. A recurring question remains as to whether or not the data represent good science and if so, whether or not to use these data.
16. Japanese Biomedical Experimentation During the World War II Era 463
Sheldon H. Harris, PhD
The Japanese experiments in China during World War II are perhaps less well known than those of the Nazi physicians, but equal them in scope and in harm to their victims. However, there was no Japanese equivalent to the Nuremberg physician’s trial. This raises obvious questions with very interesting implications.
17. The Cold War and Beyond: Covert and Deceptive American Medical Experimentation by 507
Susan E. Lederer, PhD
Examination of the history of experimentation in America before, during, and after World War II provides an opportunity to review unethical research in a democratic society so that one can learn and possibly prevent their ever occurring again.
18. Medical Ethics in Military Biomedical Research 533
Michael E. Frisina, MA
The very concept of biomedical research in the military raises ethical questions. However, it is possible to obtain good data while adhering to principles of research ethics.
19 The Human Volunteer in Military Biomedical Research 563
Paul J. Amoroso, MD and Lynn L. Wenger, MSBA
Human subject research within the military raises unique issues, including concerns for coercion, adequacy of informed consent, and use of epidemiologic data obtained for different purposes. There are more stringent regulations in place within the military than in the civilian sector to safeguard against potential violations of human
subject research ethics.
20. Nursing Ethics and the Military 661
Janet R. Southby, RN, DNSc
Ethics in nursing has a rich history, one which the military has helped develop. Ethics as viewed by nurses is complementary to that of physicians.
21. Religious and Cultural Considerations in Military Healthcare 687
David M. DeDonato, MDiv, MA, BCC and Rick D. Mathis, JD, MDiv, MA
Religion and cultural practices are extremely important to medicine in the military due to frequent opportunities for interaction with other cultures. The study of views of wellness and illness can assist health care professionals address conflicts arising from religious and cultural differences.
22. Societal Influences and the Ethics of Military Healthcare 719
Jay Stanley, PhD
In a civilian controlled military, societal influences are a major factor in military medicine and its ethics.
23. Military Medicine in War: The Geneva Conventions Today 739
Lewis C. Vollmar, Jr, MD, MBA, MA (Law)
The Geneva Conventions, as they pertain to medical personnel and their patients, provide specific reciprocal privileges and obligations. They exist to attempt to ensure safety and an appropriate level of care for those sick, wounded, or captured.
24. Military Medicine in Humanitarian Missions 773
Joan T. Zajtchuk, MD, Spec in HSA
Examining the history of military medicine in humanitarian missions provides an understanding of its changingrole. Lessons learned from past efforts can help develop effective programs in the future.
25. Military Humanitarian Assistance: The Pitfalls and Promise of Good Intentions 805
Elspeth Cameron Ritchie, MD and Robert L. Mott, MD, MPH
Peacetime engagement projects and conflict-related contingency operations require different methods of planning and execution. Mistakes made in past missions highlight some of the problems associated with well-intentioned efforts. There are also unique stresses experienced by healthcare professionals working in these environments.
26. A Look Toward the Future 831
Thomas E. Beam, MD and Edmund G. Howe, MD, JD
Technological advances currently being considered provide an opportunity to develop a method for ethical analysis of those in the future. Compensatory justice may require earlier introduction of some of these lifesaving technologies within the military.
27. A Proposed Ethic for Military Medicine 851
Thomas E. Beam, MD and Edmund G. Howe, MD, JD
A possible military medical ethic could include concepts of acting primarily as a physician in almost all circumstances, voluntarily limiting the exercise of power, and advancing the concept of compensatory justice. Exceptions to these general precepts need careful analysis and justification.
Afterword 867
Abbreviations and Acronyms xix
Index xxiii

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